What should I Have Done?

[caring angel]

Hello Friends,

I was doing a phone pacemaker check when my CNA came to me that a

resident had raised her recliner up to high and had slid out onto the floor.

Was not bleeding or moaning in pain. Just sitting up, she said. As soon as

my pacemaker check was complete, I examined the resident who appeared

uninjured. My D.O.N. wrote me up for not stopping the pacemaker check and going to the resident. I was to have hung up the phone and quit immediately! I feel if the resident had been bleeding and moaning that would have been different. I was terminated because she said for the resident's

safety, I could not continue there!

What do you feel I should have done in handling this situation?

caring angel regardless

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[donsouthparkeast]

As a D.O.N. I feel your termination was excessive...I do believe your attention should have been with the resident who fell, but to terminate, I wouldnt have.

[Hunter's Mom]

Sorry, I would have hung up. ABC's.

[TrudyRN]

hung up

If this was your first offense that was of concern to me, I'd have given a warning, though, not fired you.

Better luck next time.

[caring angel]

Thank you for the response. Guess I was wrong! I thought it was

important also for the pacemaker check. Was my first offense and I

thought also too stiff.

[edgwow]

Sorry,

But the slid out of chair patient could not wait. Your assessment is vital as soon as you are informed. The pacer check could have been completed at another time, unless the patient was actively having pacer difficulties.

[Murse901, MSN, RN]

Be thankful that you got away with a termination. She could have easily reported you to the state for neglect.

I'm not saying that you necessarily deserve either, though, especially for a first offense. Just saying it could have been worse. You definitely should have gotten an in-service on triage.

Having said that, you simply forgot the basics here. You were performing a routine assessment, and chose to continue your assessment in favor of attending to an incident. The details of what assessment you were performing are of no consequence. Unless the patient you were working with also was in acute distress, you had no reason not to drop everything and see to your other patient.

Just because she wasn't bleeding or moaning doesn't mean she wasn't in danger. How do you know without assessing the patient that there are no broken bones or blood vessels? Just having a CNA tell me that story would send a red flag to me. I have never heard of a patient putting their recliner up too high and causing them to fall out of the recliner. Sounds like a made up story to me. But then, I'm cynical like that.

Regardless, take this as a lesson learned, be thankful that you don't have to appear before the BON, and move on.

[jjjoy, LPN]

This something that gets me about nursing. Here is an honest mistake that can be learned from. It wasn't all out neglect. She wasn't waiting to check on the patient because she was reading a magazine. It wasn't that her prioritizing was totally off, as per the CNA report she perceived the patient to be in a non-life threatening sitation.

The mistake, as I see it, was in relying on the CNA's assessment of the situation instead of checking it out for herself on the chance that the patient's ABC's were at risk. It's her patient and if the CNA's assessment wasn't accurate or if the patient status changed quickly, she needed to assess the situation for herself.

Yet, I've seen many nurses who chart patient assessments that they never did, regularly take unapproved shortcuts, etc but they manage to keep their jobs presumably because they don't get caught (not like I was going to snoop around all their patients and paperwork to prove it). You might find a dressing unchanged for days or a pressure ulcer not noticed til it's fairly progressed, and no one is disciplined. Yet, someone witnesses this one incident and the nurse gets terminated?! It's good that there was a witness so she could get this important reminder (and remind us here as well) but termination seems to teach "don't get caught."

[LPN_mn]

Depending on what state the op is in the employer may feel obligated to report her to the BON because she was terminated due to pt safety issues. I just went before the BON in my state when I was terminated from a job and it had nothing to do directly with pt care. The board finally ruled that there really was no basis for my license to be reported. You may not hear anything for a while. I did not know that I had been reported to the BON until 9 months after I was terminated and received a letter from the BON. If you want to know more then pm me and I will explain in furter detail.

[withasmilelpn]

Some electric lounge chairs are made so they can raise you to an almost standing position so that is easiar for an elderly person to get out of. I've had a resident dump themselves out of the chair that way as well. Just like a slide-wheeee!

[withasmilelpn]

I also think this was an opportunity to learn. No actual harm occurred, right? But it does make you wonder, is this a resident the facility has had problems with the family? It seems like whenever someone gets fired at our facility, it is really the facility trying to cover their butts, not any real concern over the nurse's ability. I'm sorry it happened to you Caring Angel, have you found a job yet?

[NurseCard, ADN]

Sorry that this happened to you. I also agree that your DON firing you was a little excessive, but also I am not quite familiar with what a phone pacemaker check is, or how important it is, or even why you were doing it. If it were part of a routine assessment, yeah I probably also would have dropped it to go check on the fallen patient. Going solely on the CNA's word though, I can see why maybe you didn't.

Anyway, I agree that someone's family probably got pretty upset, threatened to sue, yadda yadda yadda, and that's probably why you got fired. Take it as a lesson learned and move on. LTC nurses are plenty in demand; you'll find another job. *hug*